Provider Demographics
NPI:1215530845
Name:MANGUS, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MANGUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ROLLING MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-3423
Mailing Address - Country:US
Mailing Address - Phone:440-320-4113
Mailing Address - Fax:
Practice Address - Street 1:1401 ROLLING MEADOWS DR
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-3423
Practice Address - Country:US
Practice Address - Phone:440-320-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker